GAD-Screening Tool

This is a screening measure to help you determine whether you might have Generalized Anxiety Disorder (GAD) that needs professional attention. This screening tool is not designed to make a diagnosis of GAD but to be shared with your primary care physician or mental health professional to inform further conversations about diagnosis and treatment.

Do you experience excessive worry?*

YesNo

Is your worry excessive in intensity, frequency, or amount of distress it causes?*

YesNo

Do you find it difficult to control the worry or stop worrying once it starts?*

YesNo

Do you worry excessively or uncontrollably about minor things such as being late for an appointment, miror repairs, homework, etc.?*

YesNo

Please list below the most frequent topics about which you worry excessively or uncontrollably.*

During the last six months, have you been bothered by excessive worries more days than not?*

YesNo

On a scale of 0 to 8, during the past six months, have you often been bothered by any of the following symptoms? (0=Not at All, 4=Moderately, 8=Extremely)*

	0	1	2	3	4	5	6	7	8
Restlessness or feeling keyed up or on edge
Irritability
Difficulty falling/staying asleep or restless /unsatisfying sleep
Being easily fatigued
Difficulty concentrating or mind going blank
Muscle tension

On a scale of 0 to 8, how much do worry and physical symptoms interfere with the following? [0=Not at All, 4=Moderately, 8=Extremely]*

	0	1	2	3	4	5	6	7	8
Work
Social activities
Family relationships
Friendships

On a scale of 0 to 8, how much are you bothered by worry and physical symptoms (how much distress does it cause you)? [0=Not at All, 4=Moderately, 8=Extremely]*

	0	1	2	3	4	5	6	7	8
Distressed by worry and physical symptoms

Patient Name

Patient Signature

Date

Source: Anxiety and Depression Association of America, Newman, M. G., Zuellig, A. R., Kachin, K. E., Constantino, M. J., Przeworski, A., Erickson, T., & Cashman-McGrath, L. (2002 Preliminary reliability and validity of the Generalized Anxiety Disorder Questionnaire-IV: A revised self-report diagnostic measure of generalized anxiety disorder. Behavior Therapy, 33, 215-233. doi:10.1016/S0005-7894(02)80026-0

Generalized Anxiety Disorder (GAD) Screening Tool